Home > Journals > Italian Journal of Vascular and Endovascular Surgery > Past Issues > Giornale Italiano di Chirurgia Vascolare 1999 September;6(3) > Giornale Italiano di Chirurgia Vascolare 1999 September;6(3):187-97



To subscribe
Submit an article
Recommend to your librarian





Giornale Italiano di Chirurgia Vascolare 1999 September;6(3):187-97


language: English, Italian

Preoperative intra-arterial thrombolysis in popliteal artery aneurysms complicated by acute thrombosis. Long-term results

Palumbo N., Cevolani M., Faggioli G. L., Tedesco A., Leone M.

From the Department of Surgical Science and Anesthesiology Policlinico S. Orsola, Bologna, Italy Bologna University, Italy


Aim. This ­study ­aimed to eval­u­ate the influ­ence of pre­op­er­a­tive ­intra-arte­ri­al throm­bol­y­sis ­with urok­i­nase on the ­results of pop­li­teal ­artery aneu­rysm (PAA) sur­gery com­pli­cat­ed by ­acute throm­bo­sis and to iden­ti­fy the pre­dic­tive fac­tors for suc­cess­ful sur­gi­cal revas­cu­lar­isa­tion.
Methods. A ret­ro­spec­tive ­study was ­made of the evo­lu­tion of sub­ar­tic­u­lar femor­o­pop­li­teal ­bypass oper­a­tions per­formed ­between January 1986 and December 1997 in 60 ­patients (56 ­males, 4 ­females) ­with 75 PAA. The ­mean age was 66 ­years (20-82). The eti­ol­o­gy was ath­e­rom­a­tous in 73 cas­es (97%) and mycot­ic in 2 cas­es. Aneurysms ­were divid­ed ­into 3 ­groups depend­ing on clin­i­cal pres­en­ta­tion and the ­type of treat­ment. The ­first ­group (GI) includ­ed 35 uncom­pli­cat­ed aneu­rysms under­go­ing elec­tive sur­gery, the sec­ond ­group (GII) includ­ed 27 aneu­rysms com­pli­cat­ed by ­acute throm­bo­sis and oper­at­ed in elec­tion but ­after ­intra-arte­ri­al throm­bol­y­sis ­with urok­i­nase; the ­third ­group (­GIII) com­prised 13 aneu­rysms com­pli­cat­ed by ­acute throm­bo­sis and under­go­ing emer­gen­cy sur­gery. In GI 15 cas­es ­were asymp­to­mat­ic and 20 cas­es pre­sent­ed ­signs of chron­ic ische­mia and inter­mit­tent claud­i­ca­tion. For revas­cu­lar­isa­tion pur­pos­es the saph­e­nous ­vein was ­used 50 ­times (67%), an expand­ed poly­tet­ra­flu­o­roe­thy­lene (­PTFE) ­graft was ­used 23 ­times and dardik in 2 cas­es. Lumbar sym­pa­thec­to­my was asso­ciat­ed ­with revas­cu­lar­isa­tion in 8 cas­es. The ­mean fol­low-up for GI was 48 ­months (1-112 ­months), for GII 46 ­months (1-120).
Results. The ­results ­were ­obtained ­using the actu­ar­i­al meth­od. There ­were no ear­ly throm­bos­es in GI, one ­occurred in GII and 6 in ­GIII, ­with ampu­ta­tion at the ­thigh in all cas­es. After 4 ­years the ­bypass paten­cy ­rate and ­limb sal­vage ­rate in GI ­were respec­tive­ly 81 and 91%; 78 and 85% in GII and 44 and 54% in ­GIII. Postoperative mor­tal­ity was nil in GI, and 1 ­case in GII and ­GIII. The fol­low­ing fac­tors con­trib­ut­ed sig­nif­i­cant­ly to ­bypass paten­cy and ­limb sal­vage: the dura­tion of ­acute ische­mia (p<0.005), aneu­rysm perme­abil­ity (p<0.001) and the exis­tence of at ­least two pat­ent leg arter­ies (p<0.002) at the ­time of sur­gery. The ­last two fac­tors ­were pos­i­tive­ly influ­enced by throm­bol­y­sis in ­patients ­with ­acute throm-­bosis.
Conclusions. The use of pre­op­er­a­tive ­intra-arte­ri­al throm­bol­y­sis in PAA com­pli­cat­ed by ­acute throm­bo­sis ­gives ­good ­short and ­long-­term ­results ­that are bet­ter ­than ­those ­achieved ­using emer­gen­cy sur­gery.

top of page